Re: Lymph node sampling in Wilms tumor—Getting risk based therapy right

Risk-based therapy for Wilms tumor (WT) is based on clinical, histological, and biological factors [1]. In particular, the presence or absence of disease in hilar and regional lymph nodes is critical to accurately stage a child with WT. This is true whether or not the child undergoes a primary nephrectomy or after induction chemotherapy. Several studies have documented the presence or absence of lymph node disease as the most important stage III prognostic factor for EFS or OS [2,3]. Even in children with stage IV disease, local staging is vital because it will determine the need for local radiation therapy.